Adjuvant trastuzumab reduces locoregional recurrence in women who underwent mastectomy without radiation therapy for HER-2-positive breast cancer: a retrospective analysis with propensity score matching

中华放射肿瘤学杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.1004-4221.2019.11.007

H. Jing, Shulian Wang, Yu Tang, Yong-wen Song, H. Fang, Jianyang Wang, Jiang-hu Zhang, J. Jin, Yueping Liu, S. Qi, Yuan Tang, Ning Li, Bo Chen, N. Lu, Yexiong Li

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Abstract

Objective To investigate the locoregional benefit from adjuvant anti-HER-2 target therapy and the possibility of omitting postmastectomy radiation therapy (PMRT) in HER-2 positive breast cancer patients. Methods Clinical data of 1398 patients diagnosed with HER-2+ breast cancer admitted to our hospital who underwent mastectomy without PMRT from 2009 to 2014 were retrospectively analyzed, and 370 of them received adjuvant anti-HER-2 target therapy mainly with trastuzumab. Results Anti-HER-2 target therapy significantly improved the disease-free survival (DFS) and overall survival (OS), whereas reduced the locoregional recurrence (LRR) insignificantly. Multivariate analysis demonstrated that anti-HER-2 target therapy improved the locoregional recurrence-free survival (LRRFS)(P=0.06). After propensity score matching, the 5-year LRR rate was 4.4% vs. 6.4%(P=0.070) for those treated with and without anti-HER-2 target therapy. Subgroup analysis revealed that the locoregional control benefit was only significant in patients with pathological Grade Ⅰ-Ⅱtumors (2.5% vs. 5.9%, P=0.046). For patients with pN1 tumors with and without anti-HER-2 target therapy, the 5-year LRR rate was 8.2% vs. 12.3%(P=0.150). Patients with hormone receptor-positive tumors obtained significant benefit from anti-HER-2 target therapy. The 5-year LRR rate could be less than 5% in patients with favorable risk factors who received anti-HER-2 target therapy. Conclusions Anti-HER-2 target therapy with trastuzumab can improve the LRRFS of patients with HER-2+ breast cancer after mastectomy. Nevertheless, patients with radiotherapy indications have to receive radiotherapy due to relatively high recurrence rate. Newly approved dual HER-2 blockade is a promising approach to further reduce LRR. Subgroup analysis is required to identify the low-risk patients. Key words: Breast neoplasm/target therapy; HER-2 gene; Locoregional recurrence; Locoregional recurrence-free survival

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辅助曲妥珠单抗减少了未接受HER-2-阳性乳腺癌症放射治疗的乳房切除术妇女的局部复发：倾向评分匹配的回顾性分析

目的探讨辅助抗HER-2靶向治疗癌症HER-2阳性乳腺癌的局部疗效及省略术后放疗（PMRT）的可能性。方法回顾性分析我院2009-2014年收治的1398例HER-2+乳腺癌症患者在未经PMRT的情况下行乳房切除术的临床资料，其中370例患者接受了以曲妥珠单抗为主的辅助抗HER-2靶向治疗。结果抗HER-2靶向治疗能显著提高患者的无病生存率（DFS）和总生存率（OS），但局部复发率（LRR）降低不显著。多因素分析表明，抗HER-2靶向治疗提高了局部无复发生存率（LRRFS）（P=0.06）。在倾向评分匹配后，接受和不接受抗HER-2目标治疗的患者的5年LRR率分别为4.4%和6.4%（P=0.070）。亚组分析显示，局部区域控制获益仅在病理性Ⅰ-Ⅱ级肿瘤患者中显著（2.5%对5.9%，P=0.046）。对于有和没有抗HER-2靶向治疗的pN1肿瘤患者，5年LRR率为8.2%对12.3%（P=0.050）。激素受体阳性肿瘤患者从抗HER-2目标治疗中获得显著获益。在接受抗HER-2靶向治疗的具有有利危险因素的患者中，5年LRR率可能低于5%。结论曲妥珠单抗抗HER-2靶向治疗能改善癌症HER-2+患者乳房切除术后的LRRFS。然而，有放疗指征的患者由于复发率相对较高，不得不接受放疗。新批准的双重HER-2阻断是一种有希望进一步降低LRR的方法。需要进行亚组分析以确定低风险患者。关键词：乳腺肿瘤/靶向治疗；HER-2基因；局部复发；局部无复发生存率

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中华放射肿瘤学杂志

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期刊介绍： The Chinese Journal of Radiation Oncology is a national academic journal sponsored by the Chinese Medical Association. It was founded in 1992 and the title was written by Chen Minzhang, the former Minister of Health. Its predecessor was the Chinese Journal of Radiation Oncology, which was founded in 1987. The journal is an authoritative journal in the field of radiation oncology in my country. It focuses on clinical tumor radiotherapy, tumor radiation physics, tumor radiation biology, and thermal therapy. Its main readers are middle and senior clinical doctors and scientific researchers. It is now a monthly journal with a large 16-page format and 80 pages of text. For many years, it has adhered to the principle of combining theory with practice and combining improvement with popularization. It now has columns such as monographs, head and neck tumors (monographs), chest tumors (monographs), abdominal tumors (monographs), physics, technology, biology (monographs), reviews, and investigations and research.